Remote Monitoring Of Vital Signs Research Articles

Health Care After the COVID-19 Pandemic and the Influence of Telemedicine

Health Care After the COVID-19 Pandemic and the Influence of Telemedicine

Envisioning the Post-COVID-19, Pre-Vaccine Emergency Department.

Envisioning the Post-COVID-19, Pre-Vaccine Emergency Department.

ViMo: Multiperson Vital Sign Monitoring Using Commodity Millimeter-Wave Radio

The continuous development of 802.11ad technology provides new opportunities in wireless sensing. In this work, we propose ViMo, a calibration-free remote vital sign monitoring system that can detect stationary/nonstationary users and estimate the respiration rates (RRs) as well as heart rates (HRs) built upon a commercial 60-GHz WiFi. The design of ViMo consists of two key components. First, we design an adaptive object detector that can identify static objects, stationary human subjects, and human in motion without any calibration. Second, we devise a robust HR estimator, which eliminates the respiration signal from the phase of the channel impulse response (CIR) to remove the interference of the harmonics from breathing and adopts dynamic programming (DP) to resist the random measurement noise. The influence of different settings, including the distance between a human and the device, user orientation and incidental angle, blockage material, body movement, and conditions of multiuser separation is investigated by extensive experiments. The experimental results show that ViMo monitors user’s vital signs accurately, with a median error of 0.19 and 0.92 breaths per minute (BPM), respectively, for RR and HR estimation.

Digital health care solution for proactive heart failure management with the Cordella Heart Failure System: results of the SIRONA first‐in‐human study

AimsIncorporation of remote monitoring of pulmonary artery pressure and vital signs has been demonstrated to reduce heart failure (HF) hospitalization and all‐cause mortality in selected symptomatic HF patients. The aim of this study is to investigate the safety and accuracy of the new CordellaTM Pulmonary Artery Pressure Sensor (Endotronix, Inc., Chicago, IL, USA) and the usability of the comprehensive CordellaTM Heart Failure System (CHFS).Methods and resultsMulticentre, open‐label, first‐in‐human, feasibility study to evaluate the CHFS and the safety and accuracy of the Cordella™ Pulmonary Artery Pressure Sensor in 15 patients with New York Heart Association class III HF. All patients were successfully implanted with the Cordella Pulmonary Artery Pressure Sensor, without sensor failure. No device system‐related complications, defined as invasive treatment, device explant or death, occurred. The primary efficacy endpoint of a mean pulmonary artery pressure at 90 days was met in all but one patients with a cohort difference of 2.7 mmHg (Cordella Sensor 22.5 ± 11.8 mmHg, Swan–Ganz catheter 25.2 ± 8.5 mmHg). One patient did not go through the 90‐day right heart catheterization for safety reasons. Patient adherence to daily measurement, transmission of vital signs and pulmonary artery pressure sensor readings were recorded 99% of the time.ConclusionThe initial experience of the CHFS incorporating comprehensive vital signs and pulmonary artery pressure monitoring enables safe and accurate monitoring of HF status.

Towards a Remote Monitoring of Patient Vital Signs Based on IoT-Based Blockchain Integrity Management Platforms in Smart Hospitals.

Over the past several years, many healthcare applications have been developed to enhance the healthcare industry. Recent advancements in information technology and blockchain technology have revolutionized electronic healthcare research and industry. The innovation of miniaturized healthcare sensors for monitoring patient vital signs has improved and secured the human healthcare system. The increase in portable health devices has enhanced the quality of health-monitoring status both at an activity/fitness level for self-health tracking and at a medical level, providing more data to clinicians with potential for earlier diagnosis and guidance of treatment. When sharing personal medical information, data security and comfort are essential requirements for interaction with and collection of electronic medical records. However, it is hard for current systems to meet these requirements because they have inconsistent security policies and access control structures. The new solutions should be directed towards improving data access, and should be managed by the government in terms of privacy and security requirements to ensure the reliability of data for medical purposes. Blockchain paves the way for a revolution in the traditional pharmaceutical industry and benefits from unique features such as privacy and transparency of data. In this paper, we propose a novel platform for monitoring patient vital signs using smart contracts based on blockchain. The proposed system is designed and developed using hyperledger fabric, which is an enterprise-distributed ledger framework for developing blockchain-based applications. This approach provides several benefits to the patients, such as an extensive, immutable history log, and global access to medical information from anywhere at any time. The Libelium e-Health toolkit is used to acquire physiological data. The performance of the designed and developed system is evaluated in terms of transaction per second, transaction latency, and resource utilization using a standard benchmark tool known as Hyperledger Caliper. It is found that the proposed system outperforms the traditional health care system for monitoring patient data.

Remote Monitoring of Vital Signs in Diverse Non-Clinical and Clinical Scenarios Using Computer Vision Systems: A Review

Techniques for noncontact measurement of vital signs using camera imaging technologies have been attracting increasing attention. For noncontact physiological assessments, computer vision-based methods appear to be an advantageous approach that could be robust, hygienic, reliable, safe, cost effective and suitable for long distance and long-term monitoring. In addition, video techniques allow measurements from multiple individuals opportunistically and simultaneously in groups. This paper aims to explore the progress of the technology from controlled clinical scenarios with fixed monitoring installations and controlled lighting, towards uncontrolled environments, crowds and moving sensor platforms. We focus on the diversity of applications and scenarios being studied in this topic. From this review it emerges that automatic multiple regions of interest (ROIs) selection, removal of noise artefacts caused by both illumination variations and motion artefacts, simultaneous multiple person monitoring, long distance detection, multi-camera fusion and accepted publicly available datasets are topics that still require research to enable the technology to mature into many real-world applications.

Reliability of a wearable wireless patch for continuous remote monitoring of vital signs in patients recovering from major surgery: a clinical validation study from the TRaCINg trial

ObjectiveTo validate whether a wearable remote vital signs monitor could accurately measure heart rate (HR), respiratory rate (RR) and temperature in a postsurgical patient population at high risk of complications.DesignManually...

Postoperative Remote Monitoring of Vital Signs in Older Cardiac Surgery Patients

Postoperative Remote Monitoring of Vital Signs in Older Cardiac Surgery Patients

Systematic Review of Platforms Used for Remote Monitoring of Vital Signs in Patients With Hypertension, Asthma and/or Chronic Obstructive Pulmonary Disease

The research in telemedicine has been evolving for several years, nevertheless, there isn’t a clear designation of which hardware and/or software tools should those who intend to research on this topic use. Given this situation, the objective of this study is to review and established the most used electronic cards and microcontrollers in vital signs remote monitoring systems for specific chronic patients. Also, this research intended to identify which are the motivations, challenges and recommendations to serve this study as support for further research in this area. To accomplish the above, four databases: ScienceDirect, PubMed, Science AAAS and IEEE Xplore, as well as the search engine Google Scholar academic referents, were used for developed literature review. Likewise, among 330 abstracts were searched to determine their relevance and affinity regarding the targeted scope. At the end, 35 documents were selected due to their high level of importance. According to the information extracted from such scientific papers, Arduino ONE electronic development platform has been the most used (considering low-end embedded devices) for the creation of this type of systems since 2016. Further into the review, the followed process and conclusions will be detailed and further explored.

Cardioconnect©: A digital remote monitoring and coaching pilot project for discharged Acute Coronary Syndrome and Heart Failure patients. First in Man Experience

Despite modern therapy, many patients remain at high risk for major complications following an acute coronary syndrome (ACS) or acute heart failure (AHF) episode. More than half of early readmissions are due to patient non-compliance or lack of surveillance. Patients should actively be empowered to manage their condition. This objective can be achieved by offering a combination of remote monitoring of symptoms and vital signs together with patient education, and lifestyle advice. The objective of this proof of concept trial was to test the feasibility, performance and usability of a new digital remote monitoring and coaching program in patients being discharged after ACS or AHF. Patients were included for a period of 3 months in 2017. Adherence to telemonitoring, medication, patient satisfaction and reliability of technology were measured. Key performance indicators include% of daily measurements, perceived impact on quality of life, user-friendliness of the program. Thirteen patients (11 men, 2 women) have been included. Eight patients were hospitalised for ACS, 5 for heart failure. Mean age was 56 year (32–79). The mean duration of the program was 89 days (57–126). Mean adherence to the program was 90% (69%–100%). Mean medication adherence was 92% (69,4%–100%). Patient satisfaction was quoted very high by 3 patients and high by the 10 others. Eight patients on 11 reported to be satisfied or very satisfied with the user-friendliness. No patient was re-hospitalised during the study period. The Cardioconnect© remote monitoring program was appreciated by the patients as evidenced by the high% of adherence to the program and high level of satisfaction. Therefore remote monitoring tools such as Cardioconnect© combining telemonitoring and patient coaching might be helpful in the follow-up of patients discharged after ACS and AHF. Further studies are needed to explore the role of Cardioconnect© in preventing readmission.

Continuous Versus Intermittent Vital Signs Monitoring Using a Wearable, Wireless Patch in Patients Admitted to Surgical Wards: Pilot Cluster Randomized Controlled Trial.

BackgroundVital signs monitoring is a universal tool for the detection of postoperative complications; however, unwell patients can be missed between traditional observation rounds. New remote monitoring technologies promise to convey the benefits of continuous monitoring to patients in general wards.ObjectiveThe aim of this pilot study was to evaluate whether continuous remote vital signs monitoring is a practical and acceptable way of monitoring surgical patients and to optimize the delivery of a definitive trial.MethodsWe performed a prospective, cluster-randomized, parallel-group, unblinded, controlled pilot study. Patients admitted to 2 surgical wards at a large tertiary hospital received either continuous and intermittent vital signs monitoring or intermittent monitoring alone using an early warning score system. Continuous monitoring was provided by a wireless patch, worn on the patient’s chest, with data transmitted wirelessly every 2 minutes to a central monitoring station or a mobile device carried by the patient’s nurse. The primary outcome measure was time to administration of antibiotics in sepsis. The secondary outcome measures included the length of hospital stay, 30-day readmission rate, mortality, and patient acceptability.ResultsOverall, 226 patients were randomized between January and June 2017. Of 226 patients, 140 were randomized to continuous remote monitoring and 86 to intermittent monitoring alone. On average, patients receiving continuous monitoring were administered antibiotics faster after evidence of sepsis (626 minutes, n=22, 95% CI 431.7-820.3 minutes vs 1012.8 minutes, n=12, 95% CI 425.0-1600.6 minutes), had a shorter average length of hospital stay (13.3 days, 95% CI 11.3-15.3 days vs 14.6 days, 95% CI 11.5-17.7 days), and were less likely to require readmission within 30 days of discharge (11.4%, 95% CI 6.16-16.7 vs 20.9%, 95% CI 12.3-29.5). Wide CIs suggest these differences are not statistically significant. Patients found the monitoring device to be acceptable in terms of comfort and perceived an enhanced sense of safety, despite 24% discontinuing the intervention early.ConclusionsRemote continuous vital signs monitoring on surgical wards is practical and acceptable to patients. Large, well-controlled studies in high-risk populations are required to determine whether the observed trends translate into a significant benefit for continuous over intermittent monitoring.Trial RegistrationInternational Standard Randomised Controlled Trial Number ISRCTN60999823; http://www.isrctn.com /ISRCTN60999823 (Archived by WebCite at http://www.webcitation.org/73ikP6OQz)

Postanesthesia care by remote monitoring of vital signs in surgical wards.

This narrative review summarizes recent insights into the role of remote monitoring of vital signs in the postoperative period in surgical wards. Despite recent improvements in the safety of anesthesia and surgical procedures, postoperative complication rates are still unacceptably high. This is partly attributable to the intermittent provision of personal care to patients by nurses and ward physicians. Continuous remote monitoring of vital functions in the early postoperative period may reduce these complication rates. There are several medical-grade remote monitoring platforms available that integrate a biosensor signal with electronic patient records, enabling automated prediction or notification of patient deterioration. Most available platforms have technical limitations with respect to the accuracy of respiratory rate measurements. Of note, although the implementation of automated notifications of patient deterioration is associated with a reduced activation of acute response teams, the involvement of ward physicians in the early diagnosis and treatment of subtle changes in vital functions is increased. Remote monitoring of vital signs in the surgical ward may contribute to prevention of severe complications and reduction in failure-to-rescue rates, although evidence for this association is still lacking. Anesthesiologists should contribute their knowledge and skills with respect to perioperative abnormalities in vital functions to improve patient safety during the postoperative period.

Robust real-time heart rate prediction for multiple subjects from facial video using compressive tracking and support vector machine.

Remote monitoring of vital physiological signs allows for unobtrusive, nonrestrictive, and noncontact assessment of an individual's health. We demonstrate a simple but robust image photoplethysmography-based heart rate (HR) estimation method for multiple subjects. In contrast to previous studies, a self-learning procedure of tech was developed in our study. We improved compress tracking algorithm to track the regions of interest from video sequences and used support vector machine to filter out potentially false beats caused by variations in the reflected light from the face. The experiment results on 40 subjects show that the absolute value of mean error reduces from 3.6 to . We further explore experiments for 10 subjects simultaneously, regardless of the videos at a resolution of 600 by 800, the HR is predicted real-time and the results reveal modest but significant effects on HR prediction.

Camera-based photoplethysmography in an intraoperative setting

BackgroundCamera-based photoplethysmography (cbPPG) is a measurement technique which enables remote vital sign monitoring by using cameras. To obtain valid plethysmograms, proper regions of interest (ROIs) have to be selected in the video data. Most automated selection methods rely on specific spatial or temporal features limiting a broader application. In this work, we present a new method which overcomes those drawbacks and, therefore, allows cbPPG to be applied in an intraoperative environment.MethodsWe recorded 41 patients during surgery using an RGB and a near-infrared (NIR) camera. A Bayesian skin classifier was employed to detect suitable regions, and a level set segmentation approach to define and track ROIs based on spatial homogeneity.ResultsThe results show stable and homogeneously illuminated ROIs. We further evaluated their quality with regards to extracted cbPPG signals. The green channel provided the best results where heart rates could be correctly estimated in 95.6% of cases. The NIR channel yielded the highest contribution in compensating false estimations.ConclusionsThe proposed method proved that cbPPG is applicable in intraoperative environments. It can be easily transferred to other settings regardless of which body site is considered.

A Model for Safe Transport of Critical Patients in Unmanned Drones with a ‘Watch’ Style Continuous Anesthesia Sensor

We envision unmanned aerial vehicles (UAV) for rapid evacuation of critically-ill patients from hazardous locations to health care facilities in safe zones. For safety, medical teams accompany patients to monitor vital signs and titrate anesthesia dose during transport. UAV transports would require continuous automated remote monitoring of both vital signs and of sedative dose to be feasible and safe. Volatile anesthetics (isoflurane) are the only anesthetic agents that can be monitored continuously with infrared spectroscopy (IR) devices; but unsuitable for transport. Our objective is to devise a safe UAV transport protocol incorporating novel technology for gas monitoring. Our group has developed and tested a miniaturized wearable fuel cell sensor that can detect isoflurane gas vapors as low as 40 ppm (within therapeutic range) with a sensitivity of 0.0112 nA ppm−1 cm−2. Ambient signal interference was resolved by principal component analysis (PCA). Data variance of 1st and 2nd principal components was 88.68% and 11.31%, respectively. The PCA regression model reported here can determine accurate Isoflurane concentrations. Electronic IoT platform has been built constituting micro-fuel cell, miniaturized electronic components with Bluetooth. This wearable sensor can be incorporated into a comprehensive life support system for casualty evacuation in conjunction with autonomous UAV emergency medical operations.

Recent Evolution of the Treatment of Coronary Artery Disease in China: A Conversation With Ya-Ling Han, MD, PhD.

Ya-Ling Han, MD, PhD, was born in Wuhan, Hubei province, in 1953. She graduated from Haebin Medical University in 1978. She received her doctorate in 1994 from Shanghai Second Military Medical University. She was a visiting scholar at the National Heart Center, Singapore. She is currently a professor and the director of the Department of Cardiology, General Hospital of Shenyang Military Region; the director of the Cardiovascular Research Institute; and the director of the Key Laboratory of Acute Severe Cardiovascular Treatment Research of the Chinese People’s Liberation Army. She is the president of the Chinese College of Cardiovascular Physicians and Chairperson-elect of the Chinese Society of Cardiology. Dr Rutherford asks: Could you describe the scope of clinical cardiac care provided in the Department of Cardiology at the General Hospital of Shenyang Military Region? Dr Ya-L ing Han replies : The Department of Cardiology at the General Hospital of Shenyang Military Region, together with the departments of congenital heart disease and cardiovascular surgery, constitute the cardiovascular institute of the People’s Liberation Army, which is among the top 5 centers in China providing comprehensive care for CVD. Our center is located in Northeast China, an area with the highest prevalence of CAD, so the treatment and prevention of CAD is our major focus. We are a busy center: we perform ≈7000 PCIs, 1400 radiofrequency ablations, 550 pacemaker implantations, 900 congenital heart disease interventions, and ≈2500 cardiovascular surgeries annually, with an overall in-hospital mortality rate of <1%. We have pioneered many facets of CVD treatment in China, including PCI for complicated coronary lesions, CTO of coronary arteries, left main coronary disease, treatment of high-risk patients with AMI, novel antithrombotic strategies for coronary patients, and surgical and percutaneous treatment of complicated congenital heart disease. Over the past 2 decades, you and your team have …

Continuous Remote Monitoring of Vital Signs in Pediatric Population

Background: Wearable sensor technologies coupled with secure patient portals allow for continuous real-time data acquisition from a patient in a hospital or home setting. This combination renders more effective health-management system with faster patient-recovery times and reduced healthcare costs. VitalConnect Inc. has developed a fully-disposable, FDA-cleared (for adults) wireless biosensor (VitalPatch®) that is worn on chest. VitalPatch captures multiple medical-grade biometrics and transmits the physiological data continuously (via Bluetooth) for up to 96 hours to a relay (tablet, wireless hub). Like adults, pediatric patients (5-17 years of age) could also benefit from such small and low-profile biosensor that can collect and stream vital signs uninterruptedly to a secure patient-portal. This data can then be monitored by a clinical triage center or healthcare-provider. Objective: Continuous remote monitoring of heart rate (HR) and breathing rate (BR) is critical during acute or chronic illnesses. The primary purpose of this study was to evaluate the performance of the VitalConnect platform in pediatric subjects during activities of daily living (ADL) to confirm accuracy of sensor measurements for HR and BR with respect to a clinical reference device, Capnostream20 (Oridion). Additionally, information on comfort and usability of VitalPatch at home was assessed for the total duration of wear. Methods: Thirty-five children were enrolled in the study (24 between 9-17 years, 11 between 5-8 years). All subjects participated in 96-hour wear-period of the VitalPatch biosensor and performed one hour of in-lab protocol on Day1 of the wear duration. Each participant underwent stationary breathing exercises (spontaneous, metronome), ADLs with postural maneuvers and treadmill walking. The study was conducted in presence of a nurse after approval from Institutional Review Board. The performance of heart rate, respiration rate, posture and number of steps were assessed for each subject separately using the mean absolute error (MAE) between the true and measured values. The reference for posture and step count was manual observation. Results: During the stationary condition, MAE (across 35 children) for HR and BR was 2.1±1.0 beats per minute (BPM) and 2.2±0.8 breaths per minute (BrPM) respectively compared to Capnostream20. During ADLs, MAE was 4.3±2.7 BPM for HR and 3.7±1.7 BrPM for BR. Accuracy of posture (standing, supine, walking) was >93% and step-count was >95% overall. Moreover, 80% participants rated wearing VitalPatch ‘comfortable’ without any itchiness during 96-hour wear. Conclusions: The VitalPatch biosensor demonstrated clinically-acceptable accuracy compared to a standardized reference device for both heart rate and breathing rate. It also provided sufficiently accurate measures for activity in terms of posture and number of steps. Furthermore, when used for up to 4 days at home, there were no adverse events (i.e. rashes, dermatitis, mechanical skin injury) and user experience was satisfactory. The accuracy of vitals and ease-of-use in the home environment in children aged 5-17 illustrate the potential of VitalPatch as a non-invasive and cost-effective vital sign monitoring alternative. VitalPatch biosensor can be integrated into state-of-art devices to monitor vital signs for pediatric patients with diseases like congenital heart abnormalities and adolescent fatigue. [iproc 2017;3(1):e5]

Accurate remote vital sign monitoring with 10 GHz ultra-wide patch antenna array

A patch antenna array has been presented at 10GHz frequency with improved gain (14dBi) and far-field radiation capabilities for accurate detection of human respiration and heart beat rate with Doppler radar technique. The measured and simulation antennas’ results showed good agreement. Feasibility of 10GHz channel has been studied for remote vital sign monitoring (RVSM) under Doppler radar theory. Both the breathing rate (BR) and heart rate (HR) of a man have been accurately detected from various distances ranging from 5cm to 4m with as small transmitted power as −10dBM.

Is enhanced recovery enough for reducing 30-d readmissions after surgery?

BackgroundFew enhanced recovery pathways (ERPs) include processes related to the hospital to home transfer. Little has been reported regarding readmissions in enhanced recovery programs. This study evaluates readmissions and identifies areas to optimize ERPs to prevent readmissions. MethodsWe conducted an observational, retrospective study at a single tertiary care center. Patients in an ERP for colorectal surgery were compared with a similar cohort who underwent surgery before protocol implementation. We evaluated 30-d readmission, compliance to enhanced recovery protocol, and diagnoses and patient care experiences related to transition of care. ResultsReadmission rates (17.6% versus 19.4%; P = 0.55) were similar. There was significant reduction in index hospitalization length of stay (5.3 versus 7.0 d; P < 0.001) and postoperative surgical site infection (7.3% versus 16.6%; P = 0.01). Although enhanced recovery was associated with reduced readmissions for surgical site infections (31% versus 50.7%, P = 0.02), there was a trend toward increased readmissions for small bowel obstruction–ileus (31% versus 19.1%, P = 0.13). ERPs did not impact perceptions of care transitions; however, those who were readmitted rated their transition lower than those that were not. ConclusionsAlthough ERPs did not reduce readmissions, the program was associated with reduced length of stay and surgical site infections. ERPs did not influence perceptions of the transition to home. Transition process measures aimed at reducing readmission and improving patient outcomes, including use of transition guides, remote vital sign and symptom monitoring, and early clinical follow-up have not traditionally been part of ERP protocols but should be considered.

Frequency selective surface antenna for remote vital sign monitoring with ultra-wide band doppler radar

A high gain frequency selective surface (FSS) antenna is proposed for noncontact remote vital signs monitoring (RVSM) with low power (−10 dBm) Doppler radar at 9.9 GHz frequency. High antenna gain (18.25 dBi) and narrow beam-width enhanced the accuracy of human breathing rate (BR) and heart beat rate (HR) detection from remote distance in the range of 5 cm to 1 m. Two antennas have been fabricated and tested for which the measured and simulation results showed good agreement. © 2017 Wiley Periodicals, Inc. Microwave Opt Technol Lett 59:818–823, 2017